GI ADVANCED PATHOPHYSIOLOGY EXAM ACTUAL
EXAM 200 QUESTIONS AND CORRECT DETAILED
ANSWERS (100% VERIFIED ANSWERS) |ALREADY
GRADED A+
A manifestation of liver dysfunction is impaired protein synthesis. What are the
three phenomenons related to that? - ANSWER: 1. clotting factor deficiency:
bleeding, elevated PT (vitamin K related anemia).
2. hypoalbuminemia: edema, ascites.
3. inadequate antibody production. (immunoglobulin = protein)
What is indirect bilirubin? - ANSWER: = unconjugated bilirubin
- elevated with increased RBC breakdown or impaired liver uptake
- bound by albumin so not found in urine
(Bilirubin, the end product of heme catabolism, is transported to the liver to be
conjugated and excreted via the bile. Most of the bilirubin in blood is in transit from
the tissues to the liver, in the unconjugated form, bound to albumin. Only small
amounts of conjugated bilirubin are normally found in blood, and it is believed that
the usual analytical methods tend to overestimate it in the low reference range.
Bilirubin determinations are reported in two fractions, the "conjugated" and the
"total.")
What is direct bilirubin? - ANSWER: = conjugated bilirubin
- elevated with impaired excretion of bilirubin from liver
- water soluble, so is found in urine
How is bilirubin transported? - ANSWER: unconjugated bilirubin --> liver -->
conjugated bilirubin --> gall bladder --> bile production in the gallbladder to digest
fat in the GI tract
How is bilirubin excreted? - ANSWER: - Bile
- some excreted in the stool (brown)
- Some reabsorbed into the blood stream
- very small amount, if any, excreted in the urine
(Bilirubin is excreted in bile and urine.
- the yellow color of bruises
- the yellow color of urine (via its reduced breakdown product, urobilin)
- the brown color of faeces (via its conversion to stercobilin)
- the yellow discoloration in jaundice.)
If the liver gets fibrotic and not working well which bilirubin level would be elevated?
- ANSWER: conjugated bilirubin (hepatitis, fibrosis, and cirrhosis) . In hepatitis,
fibrosis, and cirrhosis, high amounts of unconjugated bilirubin means the liver cells
, are not conjugating bilirubin normally, causing it to build up in the blood (abnormal
RBC breakdown).
If we have a plug so bile can't get out of the liver (e.g. cholelithiasia), what happened
to bilirubin? - ANSWER: increased conjugated bilirubin. --> Jaundice
(The liver converts ammonia to urea for excretion in the urine.)
What are the three causes for jaundice? - ANSWER: 1. prehapatic: increased indirect
(unconjugated) bilirubin.
2. hepatocellular: e.g. ETOH, hepatitis that increase direct bilirubin
3. cholestatis/obstructive: increase direct bilirubin
When patient has cholelithiasia, what color of stool and urine would he have? -
ANSWER: - Stool: pale, white, clay because no bilirubin in the stool.
- dark urine because elevated direct bilirubin goes to the nephrons and excrete in
the urine.
In a liver dysfunction, urea synthesis is inadequate. What happens? - ANSWER:
increased blood ammonia level (NH3). --> hepatic encephalopathy
What is the normal amino acid breakdown process? - ANSWER: amino acid
breakdown --> ammonia --> urea, excreted in urine. On standing, urea in urine
reverts to ammonia.
What are the correct precipitating factors of hepatic encephalopathy? - ANSWER: 1.
decreased potassium, sodium, and oxygen (O2).
2. increased Co2.
3. alkalosis, infection, hemorrhage, increased protein intake, renal failure,
constipation
4. sedatives
What does Lactulose (Cephulac) do? - ANSWER: Decreases pH of colon.
- decreased production of ammonia (NH3).
- reduced diffusion of NH3 from colon into blood.
- cathartic excretion of NH3.
Due to liver dysfunction, toxins and hormones are accumulated. What are the three
outcomes from it? - ANSWER: * Accumulation of toxins and hormones
1. feminization (excess estrogens)
2. poor metabolism of drugs
3. spider nevi (estrogen)
What happened to AST and ALT levels in a patient with liver dysfuction? - ANSWER:
Release of marker enzymes into body: elevated AST and ALT
EXAM 200 QUESTIONS AND CORRECT DETAILED
ANSWERS (100% VERIFIED ANSWERS) |ALREADY
GRADED A+
A manifestation of liver dysfunction is impaired protein synthesis. What are the
three phenomenons related to that? - ANSWER: 1. clotting factor deficiency:
bleeding, elevated PT (vitamin K related anemia).
2. hypoalbuminemia: edema, ascites.
3. inadequate antibody production. (immunoglobulin = protein)
What is indirect bilirubin? - ANSWER: = unconjugated bilirubin
- elevated with increased RBC breakdown or impaired liver uptake
- bound by albumin so not found in urine
(Bilirubin, the end product of heme catabolism, is transported to the liver to be
conjugated and excreted via the bile. Most of the bilirubin in blood is in transit from
the tissues to the liver, in the unconjugated form, bound to albumin. Only small
amounts of conjugated bilirubin are normally found in blood, and it is believed that
the usual analytical methods tend to overestimate it in the low reference range.
Bilirubin determinations are reported in two fractions, the "conjugated" and the
"total.")
What is direct bilirubin? - ANSWER: = conjugated bilirubin
- elevated with impaired excretion of bilirubin from liver
- water soluble, so is found in urine
How is bilirubin transported? - ANSWER: unconjugated bilirubin --> liver -->
conjugated bilirubin --> gall bladder --> bile production in the gallbladder to digest
fat in the GI tract
How is bilirubin excreted? - ANSWER: - Bile
- some excreted in the stool (brown)
- Some reabsorbed into the blood stream
- very small amount, if any, excreted in the urine
(Bilirubin is excreted in bile and urine.
- the yellow color of bruises
- the yellow color of urine (via its reduced breakdown product, urobilin)
- the brown color of faeces (via its conversion to stercobilin)
- the yellow discoloration in jaundice.)
If the liver gets fibrotic and not working well which bilirubin level would be elevated?
- ANSWER: conjugated bilirubin (hepatitis, fibrosis, and cirrhosis) . In hepatitis,
fibrosis, and cirrhosis, high amounts of unconjugated bilirubin means the liver cells
, are not conjugating bilirubin normally, causing it to build up in the blood (abnormal
RBC breakdown).
If we have a plug so bile can't get out of the liver (e.g. cholelithiasia), what happened
to bilirubin? - ANSWER: increased conjugated bilirubin. --> Jaundice
(The liver converts ammonia to urea for excretion in the urine.)
What are the three causes for jaundice? - ANSWER: 1. prehapatic: increased indirect
(unconjugated) bilirubin.
2. hepatocellular: e.g. ETOH, hepatitis that increase direct bilirubin
3. cholestatis/obstructive: increase direct bilirubin
When patient has cholelithiasia, what color of stool and urine would he have? -
ANSWER: - Stool: pale, white, clay because no bilirubin in the stool.
- dark urine because elevated direct bilirubin goes to the nephrons and excrete in
the urine.
In a liver dysfunction, urea synthesis is inadequate. What happens? - ANSWER:
increased blood ammonia level (NH3). --> hepatic encephalopathy
What is the normal amino acid breakdown process? - ANSWER: amino acid
breakdown --> ammonia --> urea, excreted in urine. On standing, urea in urine
reverts to ammonia.
What are the correct precipitating factors of hepatic encephalopathy? - ANSWER: 1.
decreased potassium, sodium, and oxygen (O2).
2. increased Co2.
3. alkalosis, infection, hemorrhage, increased protein intake, renal failure,
constipation
4. sedatives
What does Lactulose (Cephulac) do? - ANSWER: Decreases pH of colon.
- decreased production of ammonia (NH3).
- reduced diffusion of NH3 from colon into blood.
- cathartic excretion of NH3.
Due to liver dysfunction, toxins and hormones are accumulated. What are the three
outcomes from it? - ANSWER: * Accumulation of toxins and hormones
1. feminization (excess estrogens)
2. poor metabolism of drugs
3. spider nevi (estrogen)
What happened to AST and ALT levels in a patient with liver dysfuction? - ANSWER:
Release of marker enzymes into body: elevated AST and ALT
